Home-based palliative care delivery by a freelancing palliative care specialist to terminally ill cancer patients in Kolkata, India: An audit of the service model.

Abstract

e24045 Background: Home-based palliative care (HBPC) can provide continuity of care, symptom-management and end-of-life-care (EOLC) support to terminally-ill cancer patients who often have high care-giving needs. In a resource-constrained setting like India, access to community-based palliative care and EOLC is limited. We developed a model of palliative care delivery by training one of our departmental medical officers to provide HBPC as a freelancing palliative care specialist physician. This is an audit to evaluate the service utilization, patient clinical characteristics ,outcomes, and caregiver satisfaction amongst the patients receiving HBPC over three years in this model. Methods: This is a retrospective study including consecutive oncology patients enrolled between January 2022 and December 2024 in our HBPC model. De-identified patient data was extracted from our database and electronic medical health records, including demographics, diagnosis, symptom burden by Edmonton symptom scale with score of ≥4 considered significant, palliative interventions, requirement to shift at hospital, time from referral to death and caregiver feedback via Likert scale. Descriptive statistics were applied. Results: A total of 160 patients were included (median age 59 years; 56% male).The most common cancers were head-and-neck (22%), gastrointestinal (18%), and breast (16%). Mean survival of the patients from referral to death was 17.5 ± 8.5 days. Pain management was the leading reason for referral (78%).The other common reasons were wound-care and dressing including bedsores (24%), breathlessness (18%), terminal delirium (8%), nutritional management (15%), lymphedema & DVT management (6%). 82% received exclusive home care till death while 18% required hospital admission for intractable symptoms at end of life. Most common reasons for transfer to hospital were: requiring BIPAP support, unavailability of IV morphine at community level (terminal sedation), USG guided pleural or ascitic tapping & accessibility to health-insurance schemes. Common procedures performed at home included IV cannulation, Ryles tube insertion, wound management, stoma care including tracheostomy, acupuncture for pain relief, chemoport and indwelling vascular access care and ascitic tapping. Procedure-related complications were minimal (3%). Mean caregiver satisfaction score was 4.4 ± 0.6 on a 5-point scale. Conclusions: This study demonstrates that our HBPC model is safe, feasible, well-utilized and valued by families, with low complication rates and reduced hospital utilization. Structured expansion of such programs can enhance end-of-life care access and reduce health-system burden in India.